Defining patient needs and expectations for eHealth-based cardiac rehabilitation in Germany and Spain: living lab data from the TIMELY study (Preprint)

Abstract

The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions.

The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist phase III CR maintenance.

A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (n=16, 20%) and men (n=63, 80%) with coronary artery disease (CAD) (57 ± 9 years of age) participating in a structured, center-based CR program. The survey covered patients’ perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect) potentially predisposing patients to acceptance of an app/monitoring devices.

All patients owned a smartphone, whereas 30 to 40 % used smart watches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible and ~70% of patients believed that technology could help to maintain health goals after CR. Among the offered components, support for regular physical exercise including updated schedules and progress documentation was rated highest. In addition, patients rated availability of information on diagnosis, current medication, test results and risk scores as (very) useful. Of note, for each item except from smoking cessation, 35% to 50% of patients indicated a high need for support to achieve their long-term health goals, suggesting a need for individualized care. No major differences were detected between Spanish and German patients (all p > 0.05) and only younger age (p = 0.03) but not sex, educational level, or personality traits (all p > 0.05) were associated with acceptance of eHealth components.

The patient perspective collected in this study indicates high acceptance among CAD patients of personalized, user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles during phase III maintenance. The identified patient needs comprise support in physical exercise including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medication, as part of a mobile electronic health record were also rated as very useful.

ClinicalTrials.gov: NCT05461729